Integrating Risk Factors and Developing a Mortality Score for Predicting Prognosis after the Diagnosis of Tuberculosis
Article Sidebar
Main Article Content
Abstract
BACKGROUND: Tuberculosis is a major infectious disease in Thailand and worldwide. The national tuberculosis strategy implemented through the “Uniting to End TB Project” targets the elimination of tuberculosis by the year 2035 with a goal of reducing mortality by 95%.
OBJECTIVE: This study aims to develop a tool to predict the risk of death in tuberculosis patients.
METHODS: A descriptive research design was used to analyze retrospective data including patient characteristics, laboratory testing, chest X-rays, complications, and treatment outcomes of tuberculosis patients over 18 years of age at Buddhachinaraj Phitsanulok Hospital, Phitsanulok, collected between January and December 2023. The data were analyzed using both univariate and multivariate methods in order to develop a predictive score based on area under the receiver operating characteristics (AUROC).
RESULTS: Among 383 patients, 324 survived and 59 died. In the survival group, 202 were male (62.3%), while in the deceased group, 37 were male (62.7%) (p=0.96). Risk factors associated with mortality include age ≥60 years increasing the risk of death by 4.4 times (adj. OR 4.4, 95% CI 2-9.7) and having chronic kidney disease increasing the risk by 7.58 times (adj. OR 7.6, 95% CI 2.4-24.2). The risk prediction score includes variables such as age ≥60 years, chronic kidney disease, hospitalization during tuberculosis treatment, serum albumin < 3.0 g/dL, chest radiograph findings of multilobar lung infiltrates, and lymphocytes count < 720 cells/mm3, with scores of 2, 3, 2, 2, 1, and 2, respectively. This is referred to as the MAKAL-60 score, where a score of 7 yields a sensitivity of 60.3% and specificity of 94.6%, as well as a positive predictive value of 67.3%, negative predictive value of 92.8%, positive likelihood ratio of 11.08 and negative likelihood ratio of 0.42, with a probability of predicting mortality in tuberculosis patients at 94.3%.
CONCLUSIONS: The risk of death among tuberculosis patients can be monitored and followed up by using the MAKAL-60 score tool. Therefore, it is recommended that tuberculosis patients with high MAKAL-60 scores be prioritized in order to prevent, monitor, and follow up mortality in this patient group.
Thaiclinicaltrials.org number, TCTR20250114001
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
World Health Organization. Global tuberculosis report 2023 [Internet]. 2023 [cited 2024 Sep 12]. Available from: https://iris.who.int/bitstream/handle/10665/373828/9789240083851-eng.pdf?sequence=1
Ministry of Public Health. Tuberculosis situation and action in Thailand [Internet]. 2024 [cited 2024 Sep 9]. Available from: https://www.tbthailand.org/download/form/รายงานสถานการณ์และการเฝ้าระวังวัณโรคในป(1).pdf
Ministry of Public Health. National action plan for tuberculosis prevention, phase 2 (2023-2027). Nonthaburi: Ministry of Public Health; 2023.
Lyon SM, Rossman MD. Pulmonary Tuberculosis. Microbiol Spectr [Internet]. 2017 [cited 2024 Sep 30];5(1):1-10. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11687454/pdf/microbiolspec.tnmi7-0032-2016.pdf
Natarajan A, Beena PM, Devnikar AV, Mali S. A systemic review on tuberculosis. Indian J Tuberc 2020;67:295-311.
Waitt CJ, Squire SB. A systematic review of risk factors for death in adults during and after tuberculosis treatment. Int J Tuberc Lung Dis 2011;15:871-85.
Bell LCK, Noursadeghi M. Pathogenesis of HIV-1 and Mycobacterium tuberculosis co-infection. Nat Rev Microbiol 2018;16:80-90.
Hase I, Toren KG, Hirano H, Sakurai K, Horne DJ, Saito T, et al. Pulmonary tuberculosis in older adults: increased mortality related to tuberculosis within two months of treatment initiation. Drugs Aging 2021;38:807-15.
Ockenga J, Fuhse K, Chatterjee S, Malykh R, Rippin H, Pirlich M, et al. Tuberculosis and malnutrition: the European perspective. Clin Nutr 2023;42:486-92.
MacNeil A, Glaziou P, Sismanidis C, Date A, Maloney S, Floyd K. Global epidemiology of tuberculosis and progress toward meeting global targets - worldwide, 2018. MMWR Morb Mortal Wkly Rep 2020;69:281-5.
van der Sande MA, Schim van der Loeff MF, Bennett RC, Dowling M, Aveika AA, Togun TO, et al. Incidence of tuberculosis and survival after its diagnosis in patients infected with HIV-1 and HIV-2. AIDS 2004;18:1933-41.
Baker MA, Harries AD, Jeon CY, Hart JE, Kapur A, Lönnroth K, et al. The impact of diabetes on tuberculosis treatment outcomes: a systematic review. BMC Med [Internet]. 2011 [cited 2024 Sep 30];9:81. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3155828/pdf/1741-7015-9-81.pdf
Leung CC, Yew WW, Chan CK, Chang KC, Law WS, Lee SN, et al. Smoking adversely affects treatment response, outcome and relapse in tuberculosis. Eur Respir J 2015;45:738-45.
Krishnamoorthy Y, Ezhumalai K, Murali S, Rajaa S, Majella MG, Sarkar S, et al. Development of prognostic scoring system for predicting 1-year mortality among pulmonary tuberculosis patients in South India. J Public Health (Oxf) [Internet]. 2023 [cited 2024 Sep 30];45(2):e184-95. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10273380/pdf/fdac087.pdf
Jerachotechuentaveechai T, Kanchanasurakit S. Development of pulmonary tuberculosis screening tool (CEAMS-65 score) for predicting mortality rate in pulmonary tuberculosis patients. Journal of the Phrae Hospital 2022;30(1):127-42.
Prawan A, Udomdech W, Niyomthong P, Chattrapiban T. Development of a prognostic prediction model of death in new tuberculosis patient. Journal of the Phrae Hospital 2022;30(2):103-18.
Duarte EC, Bierrenbach AL, Barbosa da Silva J Jr, Tauil PL, de Fátima Duarte E. Factors associated with deaths among pulmonary tuberculosis patients: a case-control study with secondary data. J Epidemiol Community Health 2009;63:233-8.
Elhidsi M, Rasmin M, Prasenohadi. In-hospital mortality of pulmonary tuberculosis with acute respiratory failure and related clinical risk factors. J Clin Tuberc Other Mycobact Dis [Internet]. 2021 [cited 2024 Sep 30];23:100236. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8094890/pdf/main.pdf
Matos ED, Moreira Lemos AC. Association between serum albumin levels and in-hospital deaths due to tuberculosis. Int J Tuberc Lung Dis 2006;10:1360-6.